Wednesday, August 22, 2012

Doctors: When to Listen to Them, When to Ignore Them (part one of three)

Once upon a time not long ago, I went for a check-up. I felt fine, but I'd been told to have that Mitral valve prolapse checked every two years, so I chose the nearest hospital--for its proximity alone. In strode a self-confident young physician, probably a resident, who ordered a stress test in addition to the usual EKG and blood tests. The first drop in confidence came when I realized the place was a playground for medical students--each person in a white lab coat who tested me looked way under thirty, and the one who did the stress test stayed on his cell phone the entire time, inquiring whether this or that value meant what or which, and what did it mean when this happened? Halfway through the test my contact lens started hurting, and I asked to take it out. No, I couldn't do that, he said, with a sharp interpretive glance. I was sent back to the young doc who'd ordered the test.

"These are abnormal rhythms!" he said. "I think we should order an angiogram."

"Isn't that . . . like, invasive?"

"You'd be out in a couple of hours, no strenuous activity for two weeks."

"Is this really necessary?"

"You have abnormal rhythms!"

"Wait a minute--am I at risk for a heart attack? I'm not overweight, I'm not diabetic, I have low blood pressure, I have the right kind of cholesterol, and I feel fine--I have no symptoms."

"You know--" here he really stuck out his jaw--"one day, that heart muscle could just decide to stop working!!"

I leaned across the table. All of a sudden my heart, which I had never noticed before except in romantic situations, was thumping almost painfully. I was definitely scared. But I asked anyway:

"Listen, if you were me, with my heart and my cholesterol levels and my weight and my age and my gender, would you really get this test done?"

He wagged his finger at me, schoolmaster-style: "THE POINT IS!" Now he was yelling, "THE POINT IS that your heart muscle could decide to stop working!"

I said no thanks, I didn't need any test. His jaw muscle twitched.

"You will get a letter," he assured me in a rather unfriendly tone. I got a letter and took it to my primary care doctor, who told me that hospital was a "red flag" for her. I wondered if they just wanted to be able to charge for the tests, but no . . . it turns out that young doctors must perform at least 75 angiograms per year in order to keep their hospital privileges. And I guess he figured I was a safe bet--he wouldn't be doing me any harm. I did go for a second opinion, because despite the common sense I thought I possessed, I was nervous.

"You are very low risk," said Dr. Second Opinion, who was also a much older doctor, "But if you want to make absolutely sure you don't have cardiac ischemia, I could send you for a test . . . "

"Yes, yes, yes," I burbled, until I realized the test took six hours and involved dyes injected through my veins. No, no no. I left, and did some retail therapy on the way home--a really nice red shirt. Now that was good for my heart.

How well I remember a time when one of my greatest concerns was to make sure neither of my sons (then about ages one and three) grew up to b...

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